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Doctor Profile |
Michael Trahan, MD
Martha Jefferson Hospital
Michael Trahan joined Martha Jefferson after six years as a surgeon and assistant professor of surgery at the Center for Weight Management, University of Texas Medical Branch (Galveston, Texas). He received his Bachelor of Science degree from Lamar University (Beaumont, Texas) and his medical degree from Texas Tech University Health Sciences Center (Lubbock, Texas).
Bariatric operations can be categorized into one of three groups based on the mechanism of action: restriction, malabsorption and some combination of both. The restrictive group includes the laparoscopic adjustable gastric banding (LAGB, Lap-Band®, REALIZE®), sleeve gastrectomy (SG) and vertical banded gastroplasty (VBG, Òstomach staplingÓ). These operations limit the amount of food that a person can eat and, very importantly, also reduce the appetite, so a person is less tempted to overeat. The gastric banding is proving to be very effective. The gastric banding done today is a silicone ring with an externally adjustable saline-filled balloon inside the ring. The band is placed around the very top of the stomach and, when adjusted appropriately, creates an hour- glass effect, which slows the flow of food. The part of the stomach above the band fills up early and empties slowly, satisfying the appetite at a much smaller volume. Another operation in this category, the sleeve gastrectomy, is a newer technique. With this operation, most of the stomach is excised by stapling parallel to the lesser curve along a sizing tube. This operation has promising early results but is without long-term studies demonstrating its efficacy. The third operation, VBG, has lost many of its proponents because of a breakdown in its efficacy over time. Many of the patients who had the operation gained the weight back a few years later.
The second category of bariatric operations is of historic and educational interests only. A malabsorptive operation does not limit the amount of food a person can eat and does nothing to control the appetite. The operation is designed to limit the body's ability t absorb most of what is ingested. Whatever is left is then rapidly expelled from the body. The jejunoileal bypass is an example of a purely malabsorptive operation. The side effects and complications from this kind of operation are prohibitive, and it is not performed anymore. continued ...